Provider Demographics
NPI:1225643554
Name:OLSZAK, OLIVIA ISABEL (CNM, WHNP)
Entity Type:Individual
Prefix:
First Name:OLIVIA
Middle Name:ISABEL
Last Name:OLSZAK
Suffix:
Gender:F
Credentials:CNM, WHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1608 SE ANKENY ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214-1448
Mailing Address - Country:US
Mailing Address - Phone:503-233-3001
Mailing Address - Fax:
Practice Address - Street 1:1608 SE ANKENY ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214-1448
Practice Address - Country:US
Practice Address - Phone:503-233-3001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-14
Last Update Date:2021-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
367A00000X
OR202103604NP-PP367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife